Original articles|Articles in Press

One vs two-stage conversions of adjustable gastric bands: An analysis of the MBSAQIP database



      Laparoscopic adjustable gastric bands (AGB) are converted at high rates to secondary bariatric procedures. The available literature on the safety of converting in one- versus two-stage process has not included large databases.


      To evaluate the safety of a one- versus two-stage conversion of AGB.


      Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), United States.


      The MBSAQIP database for the years 2020 and 2021 were evaluated. One-stage AGB conversions were identified using Current Procedural Terminology codes and database variables. Multivariable analysis was performed to determine if one- or two-stage conversions were associated with 30-day serious complications.


      There were 12,085 patients who underwent conversion from previous AGB to SG (63.0%) or RYGB (37.0%), of which 41.0% underwent conversion in one-stage and 59.0% in two-stages. Patients who underwent two-stage conversions had higher BMIs. Rates of serious complications were higher for patients undergoing RYGB compared to SG (5.2 vs 3.3%, p < 0.001), however, were similar between one-stage and two-stage conversions in both cohorts. In both cohorts, there were similar rates of anastomotic leaks, postoperative bleeding, reoperation, and readmissions. Mortality was rare and similar between conversion groups.


      There was no difference in outcomes or complications in 30-days between one- and two-stage conversions of AGB to RYGB or SG. Conversions to RYGB have higher complication and mortality rates than to SG, but there was no statistically significant difference between staged procedures. Either one- or two-stage conversions from AGB are equivalent in safety.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery for Obesity and Related Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Clapp B
        • Harper B
        • Dodoo C
        • et al.
        Trends in revisional bariatric surgery using the MBSAQIP database 2015-2017.
        Surg. Obes. Relat. Dis. 2020; 16: 908-915
        • Vanetta C
        • Dreifuss N. H
        • Schlottmann F
        • Baz C
        • Masrur M. A
        Bariatric Surgery Conversions in MBSAQIP Centers: Current Indications and Outcomes.
        Obes. Surg. 2022; : 3248-3256doi
        • Pujol-Rafols J
        • Al Abbas A. I
        • Devriendt S
        • et al.
        Conversion of Adjustable Gastric Banding to Roux-en-Y Gastric Bypass in One or Two Steps: What Is the Best Approach? Analysis of a Multicenter Database Concerning 832 Patients.
        Obes. Surg. 2020; 30: 5026-5032
        • Oyefule O
        • Do T
        • Karthikayen R
        • et al.
        Secondary Bariatric Surgery—Does the Type of Index Procedure Affect Outcomes After Conversion?.
        J. Gastrointest. Surg. 2022; 26: 1830-1837
        • Thomopoulos T
        • Podetta M
        • Studer A. S
        • et al.
        Efficiency of Laparoscopic One-Step Revision of Failed Adjusted Gastric Banding to Gastric Sleeve: a Retrospective Review of 101 Consecutive Patients.
        Obes. Surg. 2019; 29: 3868-3873
        • Spaniolas K
        • Yang J
        • Zhu C
        • et al.
        Conversion of Adjustable Gastric Banding to Stapling Bariatric Procedures: Single- or Two-stage Approach.
        Ann. Surg. 2021; 273: 542-547
        • Al-Kurd A
        • Grinbaum R
        • Mizrahi I
        • et al.
        A comparison between one- and two-stage revisional gastric bypass.
        Surg. Endosc. 2019; 33: 1459-1464
        • Carandina S
        • Genser L
        • Bossi M
        • et al.
        Laparoscopic sleeve gastrectomy after failed gastric banding: is it really effective? Six years of follow-up.
        Surg. Obes. Relat. Dis. 2017; 13: 1165-1173
        • Schneck A. S
        • Lazzati A
        • Audureau E
        • et al.
        One or two steps for laparoscopic conversion of failed adjustable gastric banding to sleeve gastrectomy: A nationwide French study on 3357 morbidly obese patients.
        Surg. Obes. Relat. Dis. 2016; 12: 840-848
        • Marion Y
        • Eid Y
        • Menahem B
        • et al.
        What to Propose After Failed Adjustable Gastric Banding: One- or Two-step Procedure?.
        World J. Surg. 2020; 44: 3423-3432
        • Zadeh J
        • Le C
        • Ben-David K
        Safety of adjustable gastric band conversion surgery: a systematic review and meta-analysis of the leak rate in 1- and 2-stage procedures.
        Surg. Obes. Relat. Dis. 2020; 16: 437-444
      1. Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. 2021 MBSAQIP PUF User Guide. (2021).

        • Kapur A
        • Thodiyil P
        Primary laparoscopic sleeve gastrectomy versus gastric bypass: a propensity-matched comparison of 30-day outcomes.
        Surg. Obes. Relat. Dis. 2021; 17: 1369-1382
        • Spaniolas K
        • Bates A. T
        • Docimo S
        • et al.
        Single stage conversion from adjustable gastric banding to sleeve gastrectomy or Roux-en-Y gastric bypass: an analysis of 4875 patients.
        Surg. Obes. Relat. Dis. 2017; 13: 1880-1884
        • Janik M
        • Ibikunle C
        • Khan A
        • Aryaie A. H
        Safety of Single Stage Revision Laparoscopic Sleeve Gastrectomy Compared to Laparoscopic Roux-Y Gastric Bypass after Failed Gastric Banding.
        Obes. Surg. 2021; 31: 588-596
        • Carandina S
        • Maldonado P. S
        • Tabbara M
        • et al.
        Two-step conversion surgery after failed laparoscopic adjustable gastric banding. Comparison between laparoscopic Roux-en-Y gastric bypass and laparoscopic gastric sleeve.
        Surg. Obes. Relat. Dis. 2014; 10: 1085-1091
        • Berende C. A. S
        • de Zoete J.-P
        • Smulders J. F
        • Nienhuijs S. W
        Laparoscopic sleeve gastrectomy feasible for bariatric revision surgery.
        Obes. Surg. 2012; 22: 330-334
        • Alqahtani A. R
        • Elahmedi M
        • Alamri H
        • et al.
        Laparoscopic removal of poor outcome gastric banding with concomitant sleeve gastrectomy.
        Obes. Surg. 2013; 23: 782-787
        • Obeid N. R
        • Schwack B. F
        • Kurian M. S
        • Ren-Fielding C. J
        • Fielding G. A
        Single-stage versus 2-stage sleeve gastrectomy as a conversion after failed adjustable gastric banding: 30-day outcomes.
        Surg. Endosc. 2014; 28: 3186-3192
        • Stroh C
        • Benedix D
        • Weiner R
        • et al.
        Is a one-step sleeve gastrectomy indicated as a revision procedure after gastric banding? Data analysis from a quality assurance study of the surgical treatment of obesity in Germany.
        Obes. Surg. 2014; 24: 9-14
        • Van Gemert W. G
        • Van Wersch M. M
        • Greve J. W. M
        • Soeters P. B
        Revisional surgery after failed vertical banded gastroplasty: restoration of vertical banded gastroplasty or conversion to gastric bypass.
        Obes. Surg. 1998; 8: 21-28
        • Moon R. C
        • Teixeira A. F
        • Jawad M. A
        Conversion of failed laparoscopic adjustable gastric banding: Sleeve gastrectomy or Roux-en-Y gastric bypass?.
        Surg. Obes. Relat. Dis. 2013; 9: 901-907
        • Parmar C. D
        • Mahawar K. K
        One Anastomosis (Mini) Gastric Bypass Is Now an Established Bariatric Procedure: a Systematic Review of 12,807 Patients.
        Obes. Surg. 2018; 28: 2956-2967
        • Parmar C. D
        • Bryant C
        • Luque-de-Leon E
        • et al.
        One Anastomosis Gastric Bypass in Morbidly Obese Patients with BMI ≥ 50 kg/m2: a Systematic Review Comparing It with Roux-En-Y Gastric Bypass and Sleeve Gastrectomy.
        Obes. Surg. 2019; 29: 3039-3046
        • Parmar C
        • Abdelhalim M. A
        • Mahawar K. K
        • et al.
        Management of super–super obese patients: comparison between one anastomosis (mini) gastric bypass and Roux-en-Y gastric bypass.
        Surg. Endosc. 2017; 31: 3504-3509